Page 146 - Community pharmcy practice E-book 2025

02/11/2025, 00:29

4. Menstrual Disorder (Menstrual Pain / Dysmenorrhea)

Etiology
• Primary dysmenorrhea: crampy lower abdominal pain associated with menstruation in
absence of identifiable pelvic pathology; associated with increased uterine prostaglandin release
leading to uterine hyper-contractility, reduced uterine blood flow.
• Secondary dysmenorrhea: pain due to underlying pathology (e.g., endometriosis, fibroids,
pelvic inflammatory disease, adenomyosis).
• Other menstrual disorders may include irregular bleeding, heavy menstrual bleeding, pre-
menstrual syndrome (PMS) – though for self-care the pharmacist focuses often on pain/cramps.
• Pharmacist role: help women self-manage mild pain, identify when referral needed for
underlying disorder.

Symptoms
• Onset typically just before or at the start of menstrual flow; pain is sharp or dull crampy in
lower abdomen/pelvis, may radiate to lower back/thighs.
• Associated symptoms: nausea, vomiting, diarrhoea, headache, fatigue, dizziness.
• Symptoms usually last 1–2 days or until flow settles (primary). Secondary dysmenorrhea
may present later in life, with additional features (pain outside menses, heavy bleeding,
dyspareunia).

Referral Cases
Refer to physician if:
• Pain is “new” or changed in pattern (e.g., started later in life, after childbirth).
• Pain persists beyond first 1-2 days of menstruation or occurs outside menses.
• Heavy menstrual bleeding (soaking > 1 pad hourly), passing large clots, or associated
anaemia.
• Associated with dyspareunia (painful intercourse), infertility issues, abnormal uterine
bleeding, intermenstrual bleeding.
• Suspected secondary cause (e.g., endometriosis, fibroids, PID).

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